Where Health Reform, Medical Innovation, and Physician Practices Meet - The Leading Voice for Medical Innovation on the Internet

Sunday, March 31, 2013

Innovation
Myths

Myth
is the secret opening though which the inexhaustible energies of the cosmos
pour into human cultural manifestation. Religions, philosophies, arts, the
social forms of primitive and historic man, prime discoveries in science and
technology, the very dreams that blister sleep, boil up from the basic, magic
ring of truth.

Joseph
Campbell (1904-1987),American
Mythologist,author of The Power of Myth

Innovation is boiling up out there.I can’t put my finger on it.But part of it is about myths of
innovation.Since I started promoting an
online forum of healthcare innovation a month ago, hits on
my medinnovation blog have tripled.

Yet myths persist
about innovation. “Innovation” is a chameleon
word. It means different things to different people. Everybody wants to be
innovative. Innovation creates a magical feeling. It is considered a creative
path out of the morass and away from the edges of the abyss.

Here are a few of the myths.

·Innovation
belongs to the young.This
may be because the young have created
many of Internet innovations – Google, Facebook, Microsoft, Intel, Apple,
Cisco, Twitter, Amazon, eBay, You-Tube, and others.Last week, Yahoo bought the news-reading app
of Nick S’Alioso, 17, for a $ billion or so.But the young may be exceptions.Most innovators who win the Nobel Prize
average 60 and took 20 years to get the prize (Tom Agan, “Why Innovators Get
Better with Age", NYT, March 31, 2013).

·Innovation
occurs mostly among individuals working out of their garage, dorm room, and
makeshift office.In truth, most innovations come out of the
corporate world with teams of individuals or joint ventures with health care organizations, all striving for goals that make a difference
for their companies in a competitive world. The future of innovation is more
likely to lie with health care corporations working with Internet and data
based technology companies.

·Innovation
is strictly about creativity.In actuality innovation is just as much about money.Capital, and access to it, is what differentiates America from competitors
in Europe, Japan, and elsewhere,America is the venture capital center of the world. And in places like Silicon Valley, venture
capital, communications between entrepreneurs, and innovation know-how have come together to create a climate for
producing and implementing creativity.

·Innovation
is unique to America and Americans -To certain extent this is true, given our traditions and conditions of risk taking and economic freedoms of our
democracy. But many U.S innovations come
from foreign enterpreneurs who have come to American to practice their craft. Access to private capital and government and corporate investments in
R&D may be even more important preconditions for innovative breakthroughs than the form of government or nature of a society( Edward Conard, Unintended
Consequences: Why Everything You’ve Been Told about the Economy are Wrong,
Portfolio/Penguin, 2012; Eamon Fingleton, “America the Innovative, “ NYT, March
31, 2013).

·Most
innovation can be traced to the Internet -The U.S. has certainly capitalized on the Internet to
accelerate U.S productivity which remains the wonder of the world. We work harder and faster than any other
nation with fewer workers producing more product than our rivals. This holds true for our health system as well,
which has fewer physicians per capita than most developed countries.In the short run, this health care productivity
may go down with more regulations,shorter working hours per physician,more women physicians, who have more family obligations outside of practice;more salaried physicians,and physician desire for balanced lives. In the long run, however, the Internet,telemedicine,mobile apps,Skype-like and email
communications, and monitoring devices
promise to increase productivity.

Tweet:Certain
preconceptions – that innovation belongs
to the young,individuals, the inherently creative, and to
Americans – are myths.

To review one’s own book is height of ego. So this
will be short.Very short. The book has sold 83 copies so far. I would
like to sell more.It’s about decline in
private practices,physician shortages,loss of physician morale, unintended
consequences of health reform law,and their effects on physicians. . It is based on series of national surveys by
the Physicians Foundation. One survey involved 630,000 practitioners, the largest of its kind ever undertaken.

Buy it. Enjoy it. Learn from it.Purchase it at 1-203-245-3959 or
rjjulia@ondemandbooks.Thanks for
listening.

Saturday, March 30, 2013

·Delos Cosgrove, MD,CEO of the $5 billion Cleveland Clinic,
predicts government, which now pays for 50% of total health costs, may soon pay
for 75% costs.

·Merritt Hawkins,the nation’s largest physician recruiting firm,
believes 75% of physicians will be employed by hospitals and large health care
organizations by 2020 and probably ooner.

What would health care look like if these 75%
scenarios came to pass?

1.If the income tax goes to 75% in the U.S., it would result in capital flight
from the U.S., as it has in France.But
where would the rich go? As matters stand in U.S. now,the effective U.S. top rate is 39.5%, but it
is more like 45% if you throw in other taxes, like the 3.8% Obamacare tax, new
Medicare taxes, the payroll tax, and other
hidden taxes.Keep in mind that many
blue statesalready effectively tax
income at 50%. But, given Americans’ dislike of high taxes and big government, the 75% rate is highly unlikely in the US. Still, on a smaller scale, capital flight is
already occurring in the U.S. – from high
tax Blue States – California, New York, the Midwest, the NE corridor- to Red
States – particularly those with no income tax – Florida, Texas, Tennessee (“Laffer
and Moore: The Red-State Path to Prosperity,” WSJ, March 27, 2013).

2.If and
when government pays for 75% of all health costs, there will likely be a massive migration
of patients and physicians out of the system to concierge and cash only
practices,to any setting that is free
of third party restrictions and paperwork, to self-funding by large and small
businesses,to health savings accounts
with high deductiblesaway from PPOs and
HMOs, to anything with lower premiums and more freedom of choice, to the
underground economy . It will not be pretty. It will be chaotic.

But this is what happens in a country that prefers individualism to collectivism and the freedom to do what one wants in a nanny-free environment.

3.If
hospitals and large integrated health systems employ 75% of doctors, including physicians,
a colossal consolidation into larger and larger entities with capital, administrative,
analytical, and technological resources will take place.These huge entities will have enough wherewithal
to establish monopolies, to fend off
government, and to negotiate larger
payments from health plans Hospitals will charge higher fees for
physician services to offset losses from declining numbers of beds, dwindling Medicare
revenues, and losses from less-productive physician practices.Physician productivity will drop about 30% as physicians become salaried
employees.Some of these entities will
take the form of accountable care organizations.Government antitrust actions will ensue, In
a worst case scenario,a physician
shortage will occur, as physicians drop out of workforce,work part-time, or seek non-clinical work,
and there are not enough nurse practitioners or physician assistants to take up the slack or fill the primary
care gap.

I hope none of these 75% scenarios
happens.I would not like to be labeled as “Doctor
Worst-Case Scenario.”

Tweet:
Worst-case scenarios: U.S. income tax rates climb to 75%, government pays for 75% of total care,
and hospitals employ 75% of doctors.

The
obvious, which is not so obvious, and the simple, which is not so simple.

The
Practical Cogitator, 1959

The health reform endgame is obvious.

The endgame will be consumers and voters agreeing
to spendenough of their own money to
shop for and choose what they wantusing
health savings accountswith high
deductiblesfor routine care but catastrophic
ceilings to protect against economic losses and with subsidies to protect the
poor.

While this may be obvious, it is not simple.

Progressives would oppose it.For them, the endgame is a government-run system that is “free” but with
regulations and an accompanying bureaucracy directed by them to control that expense and to perpetuate their political power.

Health-savings accountswould take health-care decision-making
outof the hands of government and place
it in the hands of consumers.HSAs would
disempower government.These accounts
would puncture the illusion that health
care is, or ought to be, “free’, and
that anything short of that noble goal is a moral failure.

HSAs would put the onus of choosing what is
the right care in the consumers’, employers’, physicians’, hospitals’, and
health plans’, and health suppliers’ camps, for they would have to cater to
consumers and to prove to them what they is provided at the right place, at the
right time, for the right price.Consumers, not government, would know what is “best.”

Universal HSAs would not happen overnight – or even
in a decade, or perhaps ever.Government dependency is a powerful and appealing sedative,as all utopias are.Universal HSAs would require a number of painful
steps.

·The government and voters coming to the
conclusion that the present health law is dysfunctional,does not protect consumers,and is unaffordable.

·Acknowledging that informed consumers
are in the best position to shop for what is best and affordable for their own
personalcare.

·Creating an analytical system,with stakeholders participatingat all levels,capable of delivering objective information on transparency and quality, but letting the
consumers make subjective choices of what fits their personal health and
economic interests best, given the resources at hand.

Tweet:The
ideal ultimate endgame in health reform would be for consumers to own health
savings accounts allowing them to choose their own care.

Thursday, March 28, 2013

Two Voices from My Past:Paul Ellwood, MD, and Regina Herzlinger, PhD

The past is prologue.

Shakespeare

Ellwood

Paul Elwood
called me last night from Wyoming to inform me my computer had been hacked, and
he was receiving emails asking for money to get me out of Belgium. I was
pleased to hear from him under any circumstances.We had a delightful conservation.Paul, at age 86, spoke with a clear
voice.He reminded me of his role in
reshaping health care.He has been an
advisor to multiple presidents and
persuaded President Nixon to pass the HMO act, which required businesses to
offer HMOs.He was also a principal advisor in the Clinton reform effort.Paul said he was re-entering the health reform
arena, and his chief interest was what to do with Medicare Advantage Plans.He thought Obamacare might be on the brink of becoming unraveled and wanted
to do what he could to rescue it, and some its ideas, like Accountable Care
Organizations.He reminded me that he played
a role in forming UnitedHealth, and he was astonished it was now a $115 billion
corporation.He said he still thought
the future resided in large integrated, capitated, salaried
community-based physician groups.I said
I would like to interview him about the current state of health care, which he
played such a pivotal role in creating, and he agreed to give me a hearing.

Herzlinger

Regina
Herzlinger, the first tenured woman professor at Harvard Business School, is
the subject of a flattering interview “Opening the Door” in the March issue of
the HBS Alumni Bulletin.It is largely about how she opened
opportunities for woman teachers and students at HBS.I came under her spell as a student at a
graduate course in 1976.Later she
wrote the foreword for my 2007 book Innovation-Driven Health Care: 34 Key Concepts
for Transformation (Jones and Bartlett).Her claims to fame are being selected as the best teacher at Harvard in 1997 and
a series of books, notably Market-Driven Health Care: Who Wins, Who Loses in the Transformation of
America’s Largest Service Industry (1997); Consumer-Driven
Health Care: Implications for Providers,
Payers, and Policy Makers,Consumer-Driven
Health Care (2004); and Who Killed
Health Care: America’s $2 trillion Medical Problem – and the Consumer-Driven
Cure.As the titles indicate, Regina
thinks the final solution for America’s health care will be informed health
care consumers.Of Obamacare, she says
in the interview; “I agree that the individual mandate is essential.But with Obamacare, agents who don’t know our
individual needs are selecting plans on our behalf and that’s not consumer-driven
health care.Obamacare establishes
health-care exchanges, or markets but a consumer-driven system would require transparencyin health-care quality and costs Can you
imagine shopping in a supermarket where you don’t know products’ prices or
ingredients?”

Tweet:Paul Ellwood, MD, father
of the HMO, and Regina Herzlinger, champion of consumer-driven health care are
still active in health reform.

The
element of a plan, law, strategy, or system that fails to perform as expected
and disrupts or threatens to disrupt some or all of the other elements.

Definition
of Dysfunctional

To say that Obamacare is dysfunctional as we move
towards full implementation in 2014is an understatement. Yesterday’s announcement by the Society of
Auditors that Obamacare would raise overall costs by 32% by 2017 underscores
the dysfunctionality.

Nowhere is this dysfunction more evident than in the
relationship of the Obama administration and physicians. A headline in yesterday’s Wall Street Journal “Warning Over Doctor-Run Groups” is an
example.The article warns of physician
groups owned by orthopedic and spine surgeons that serve as intermediaries between medical
device manufacturers and hospitals.The
Inspector General calls these groups “inherently suspect” and warns they “pose
dangers to public safety.”

This is not the first time a government agency has
gone up against physicians.It did so
when Congress shut down fthe building of future physician-owned hospitals.It does so when it prints 1600 pages of more regulations and piles them
upon an already over-regulated health care industry. It does so when it threatens to imprison
doctors or suspend their licenses if they do not follow Medicare compliance
rules to the letter.It does so when it forbids doctors from privately contracting
with patients. It does so when it
requires doctors to prescribe electronically and to install expensive
electronic health systems at a loss with no hope for a return on investment. It does so when it ascribes tremendous
increases in cost of care (now 18% of
GDP) to fee-for-service medicine by accusing physicians of greedilyincreasing their incomes based on volume rather
than quality. It does do when it funds
Obamacare partly by systematically reducing physician incomes at every turn
over the next decade.

What are the results of this dysfunctional
relationship?

A White Paper published by an advisory panel of the
Physicians Foundation “Health Reform and the Decline of Physician Private
Practice” sums it up nicely.

·“Most physicians will be compelled to consolidate
with other practitioners, become hospital employees, or align with large
hospitals and health systems for capital, administrative and technical
resources.”

Government is looking for a villain outside of
government, and they have found it in physicians.“Trust, but verify", Ronald Reagan’s old
saying for dealing with the evil empire has become “Distrust, but deny and comply.”This may be a winning strategy but it has one glaring problem: Patients
trust their physicians more than government.

Tweet:A
dysfunctional relationship exists between government and physicians who
distrust each other’s motives.

Wednesday, March 27, 2013

Once you put human life in human
hands, you have started on a slippery slope that knows no boundaries.

Leon Kass, MD (born 1939), American
physician who considers himself a humanist

Certain slippery
health care topics keep rearing their heads. How you think about them
depends on how far down the human slope you have slid and on how highly you
regard human decision-making.

Slippery slope topics include:One, Mandatoryspending is authoritative, compulsory,
obligatory, and ideological. Discretionary spending is left to the discretion
of health care consumers and physicians.Of the federal budget,62% is
mandatory (Medicare, Medicaid, Social Security) and 38% is discretionary (military,
domestic programs).Mandatory spending
is an increasing part of budget;
discretionary spending is declining.Mandatory spending is ideological. Most Democrats (Obama and Senate) believe
more federal dependency will win more
voters, now and in the future.

Two, Value-based
spending is determined by outcomes based on data, paying only providers who
practice evidence-based medicine. Volume-based spending is based on
fee-for-service spending regardless of “quality” based on data.Volume-based spending is winning because less
than 1% of health care spending is now based on “quality,” and progress to
payfor “value” is still very slow, with
only 10% of health plans using this criteria, though propaganda to the contrary
is immense.

Three, Consumer/physician
based spendingis based on what health consumers choose to spend on out-of-pocket
or out of their own moneyin health
savings accounts with high deductibles before they reach the deductible and
what doctors they choose to visit or rely upon.Elitist spending is based on what policy makers and government
officials think is best for the consumers, and, of course, government knows best. Consumers/physicians are winning.
Small and large companies are increasingly offering only health savings account
plans with high deductibles;and
consumers and physicians are increasingly bypassingthird parties through concierge and cash-only
practices. Where You Stand on Topics Depends on...

Where one
stands on these topics depends, of course, on where one sits;who pays and what one considers to be of “value”;and how one thinks ideologically, i.e., whether government
collectivism or market
individualismshould prevail .

In a March
25 WSJ article , “The Great Recession
Has Been Followed by the Grand Illusion,” Mort Zuckerman, chairman and editor
of U.S. News and World Report, put the problem inthis context:

“What the
administration gives us is politics. What the country needs are constructive
strategies free of ideology. But the risks of future economic shocks will
multiply so long as we remain locked in a rancorous political culture with a
leadership more inclined to public relations than hardheaded pragmatic
recognition of what must be done to restore America's vitality.”

Steven Brill made quite a splash when, in a 2400 word article in the February 20 issue of Time, the most lengthy in the history of the
magazine. Brill accused hospital executives
of ripping off Americans.

How?By
usinga billing mechanism known as
chargemaster accounts to charge exorbitant fees for everything from use of
hospital rooms, to operating rooms, to recovery rooms,to ICU rooms to Tylenol to cotton balls to band aids. The proble? Chargemaster accounts are so complex,
convoluted, and arcane that nobody seems capable of figuring them out or
unraveling them.

Alleged fee abuse may
even more complicated than that with hospitals hiring physicians in record
numbersand then upping the physicians
fees and charging “facility fees” for use of operating rooms and other
specialized facilities using physician services.As employees of the hospital,physicians no longer have any choicefor setting their fees or controlling
facility fees.

Yet it is easy to understand why hospitals impose these various fees.Hospital occupancies are dropping;Obamacare cuts $256 billion out of Medicare
funding for hospitals over the next decade; hospitals are requiredto care of all comers even if they can’t
pay;and hospital executives are not
hired to lose money.It’s hard to
criticize hospitals for trying to make up for the loss of income.

Small wonder that hospital inpatient fees are up
sharply. Once cannot blame physicians. As John Commins points out in a March 20 Healthleaders Media article:

“Hospitals look at themselves as healthcare companies and there
are a bunch of reasons why they are aligning with physicians. And it is not
just their desire to do so. Physicians are also facing this new market where
they are being asked to do more with less with regards to capital investment
and health information technology and developing a quality infrastructure
platform and malpractice and other typical costs that make it difficult for
them to continue to practice in that two- or three-doctor practice."

Brian Klepper, an independent health
care analyst, givesanother reason
.He followed the Brill piecein the March 22 issue of The Health Care Blog “Why
Only Business Can Save America from Health Care, ” with this commentary:

“Why haven’t America’s business leaders united to be a
counterweight to the health care industry’s massive influence? After all, only
one group is larger and more influential than the health care industry, and
that’s everyone else.

Part of the answer lies in the health care industry’s
masterful divide-and-conquer tactics. Every community’s most prosperous and
influential business leaders sit on local health company boards. No Chamber of
Commerce will organize efforts that oppose the egregious practices of its
largest members, the health plans and hospitals. Business health coalitions
that welcome drug and device firm subsidies are loathe to mount efforts that
might offend their benefactors.

So far, business has not displayed much appetite for
galvanizing on this issue. But the fact remains that, unless the business
community and its champions come together, health care will almost certainly
continue to have its way with Congress and the national largess, planting the
seeds of financial instability and undermining the nation’s future.”

True enough, but the answer may also
be deeper than that.To coin a phrase
from James Carville, who said, “It’s the economy, Stupid!” ’It’s structural and cultural, Stupid!”

We live in a capitalistic society
where individual fees for individual acts are expected and the norm. For
hospitals, these fees are for service lines,such as orthopedics,general surgery,
cancer and imaging; and for individual items charged to patients; and for individual
facility use – operating rooms, recovery rooms, private rooms, and ICU rooms.

Individual fees are built into American culture and
business structure., and rest on the premise that people can be trusted to
do the right thing or they will cease to be a competitive force. Obamacare proposes to change all of this by
converting fees-for-individual things into
bundled and capitatedfees for all
illness categories,episodes of
care,types of patients classified by
payer, such as Medicare. Hence, the
Accountable Care Organization.For cancer
care, for example,Ezekiel Emanuel,
MD,Obama’s former chief medical advisor
and now vice provost of the University of Pennsylvania, says one way to do this
is:

Over the next few years, a payment system needs to move away
from fee-for-service to a system of bundled payments, in which doctors are paid
one fee for all the treatments needed in care for the patient.(“A Plan to Fix Cancer Care, “ New York Times, March 24, 2013).

Lots of luck, Ezekial.Changing the fundamental structure of health
care economics will not be easy. Why?Because of the immense variations in individual doctors,individual hospitals, and individual
patients. I suppose one can minimize these individual variations by
consolidating everything into one big bundle and using reinsurance to compensate
for variations.But it won’t be
easy.There will be economic losers, who
will hire lobbyists to minimize the damage and protect the entrenched
self-interests in the hospital and the surrounding communities.

After scanning this morning’s health care news, this
question sprang (after all, it is Spring) to mind, what are the limits of
Obamacare? Obama seems to think the sky is the limit, and there is no budget deficit problem. Others see clouds and limits on the horizon.

These are questions that arise when thinking about limits.

·
Will it be the magnitude of the national
budget deficit?That is the crux of the
dispute between our two political parties. The deficit will likely exceed $20 trillion in
Obama’s 2nd term,and the big
drivers are Medicare and Medicaid.Senior fellows at the Hoover Institute think we have gone beyond that
limit, “Many current government policies are going well beyond such limits, as
shown by excessive spending and taxes, growing debt, intervention government
policy, and burdensome regulations that shave slowed growth and job creation)”A
Better Strategy for Faster Growth, “ WSJ, March 25, 2013.

·Will it be the cost of health
exchanges?I read in Robert Laszewski’s
piece in The Healthcare Blog, it will be $935 billion in California alone,the federal government will be running 33 of
these exchanges? 17 states will set up their own exchanges, with financial aid
from Washington, including $124 million for Vermont, $253 million for Kentucky,
and $252 million for Kentucky. The other 33 states will have to find their onw
money.What will be the limits for
federal and state largess, and where will the money come from?More taxes, most likely.

·Will it be doctors willingly
participating in Accountable Care organizations?No one knows for sure, but a piece in
HealthLeaders Media indicates doctors await proof of ACO performance in achieving
the magic thing called “care coordination” before jumping the private practice
ship.Why leap before Accountable Care
Organizations have proven their worth?
Primary care physicians are keeping an open-mind on the matter, with a poll indicating
70% are willing to wait and see if ACOs deliver on what CMS projects.

·Will it be the 2014 elections?Betsy McCaughey, the former lieutenant
governor of New York and author of a new book, Beating Obamacare, says the 2014 elections will set the limit
because ordinary citizens will vote to retain the GOP majority in the House and will win
back the Senate. In “Disaster for Dems” Obamacare; the 2014 Vote,” she
reasons as follows: young people (19% of those who voted for Obama) will revolt
when their premiums double; middle-class folks will shudder with 20% to 30%
premium hikes; workers in the retail, fast food, and hospitality industries won’t
like losing health coverage, experiencing premium increases, and being reduced
to part-time status; senior will be shocked by cutbacks and loss of
benefits.Chaos will reign in 2014, and
the people will votefor a GOP House and
Senate, who will overturn or defund Obamacare.

We shall see if Obamacare has limits and, if so, who and what will set these limits?

Sunday, March 24, 2013

The
Art of Obamacare Rationalization

Rationalization
is the process of not perceiving reality, but attempting to make reality fit one’s
emotions.

Ayn
Rand (1905-1982), Philosophy: Who Needs
It?

We are now engaged in the process of implementing
Obamacare.Success or failure depends on
the strength of the followers of one’s political philosophy – whether government or markets should run the
show. The outcome is difficult to predict because we are all
born a little bit liberal and a little bit conservative, whether we are for the
common good or one’s own good. We all tend to make our argument, well,
rational.

A good example of rationalization appears in this
Sunday’s lead editorial in the New York
Times.

The Times posits these four positions in its support of Obamacare.

·Expanding
coverage - The Timesreports that 6.6 million young adults under 26 are now covered under their parents’
plans; that 71 million Americans have received at least one “free” preventive
care, without co-pays or deductibles; that 34 million seniors have gotten “free”
preventive services; that 17 million children with pre-existing disease are now
covered.

As
Milton Friedman (1912-2006) said, “There
is no such thing as a free lunch.” However one rationalizes it, Obamacare is eating the lunch of private
health plans, who as stock-held companies beholden to investors,are responding by dramatically upping premiums by 20% to 30% overall, and 100% to
200% for individuals and some small businesses.

·Savings
consumers money -The
law requires health plans to spend 80% to 85% on claims and quality, rather
than on marketing or administration, or the plans have topay a rebate.Last year the health plan industry paid rebates of $1.1 billion.The law also requires discounts on drugs for
seniors,which The Times said saved seniors $6.1 billion in 2010 with more to come.

It
is inevitable that health plans will raise premiums and drug companies will
raise prices on drugs for non-seniors.When
government pushes down on the health cost balloon,increasedprices will pop out somewhere else.Neither health plans or drug firms are in the business of losing money
or profits to please government. It is the structural nature and requirement of capitalism.

·Reining
in costs -Here rationalization
reaches the level of a true art form.The Times says Obamacare,not the recession, “presumably” overall
health costs to decline over the last three years.“Presumably” possesses powerful shades of
ambiguity,And the Times hastens to add, “it is possible
that the focus on reform has led many providers to act more frugally.”It is also possible that Obamacare attacks on Medicare Advantage plans have
decreased costs by reducing “unjustifiable
overpayments to private health plans.”

Anything
is presumably possible when it comes to justifying slurs on one’s ideological
adversary.

·Better
quality of care – The Times reasons that Medicare penalties embedded in Obamacare have
reduced hospital readmissions from 19.0% to 17.8% over the last five years and
that Medicare demonstration projects, just being implemented will move
hospitals and doctors to provide “coordinated “ care, lowering costs and
elevating quality in one fell swoop,when backed by massive reams of outcome data.

Nice
try, but hikes in “quality” and drops in costs have yet to be “demonstrated,”no
matter how rational they seem on the surface. Perhaps these various
rationalizations will ,in the end , clarify our thoughts about reform. May the strongest and most rational arguments
win. The outcome will depend on political events,on how the public votes, on cost outcomes,on the level of the budget deficit, on whether doctors are available to provide necessary
care, and whether one believes government or markets can best distribute health
care services at an affordable prices in convenient locations.

Tweet:The
U.S. is engaged in a great debate rationalizing whether government or markets
can deliver what patients want out of the health system.

2.“The
tax is a burden on medicaldevice
businesses but, most importantly, it is a disincentive for jobs. It stifles
innovation, and it makes it more difficultfor the next generations of lifeesaving device to make it the market.

Innovation based on human organ growth is in.Taxes on medical devices as stiflers of innovation is out.

For wildly different reasons.

·With lab growth of human organs,researchers discovered that stem cells –
found in human bone marrow and fat and elsewhere –can be transformed into other organ tissues.Scientists at Wake Forest’s Institute for
Regenerative Medicine have grown human bladders and now at work on other bio-engineered
body parts, including blood vessels and
livers.At London’s Royal Free Hospital,
scientists have grown and transplanted a trachea.In Madrid and elsewhere, scientists are hard
at work growing hearts, ears, noses, urethras, and bile ducts.The big pay-off, scientifically and
economically,will come with a lab-built
heart parts,coronaries, valves, and
myocardial patches, and maybe, in 5 to 10 years, a whole heart.

·As for Democrats coming out to support
innovation and to repealthe
Obamacare-imposed tax on medical devices, this may come as a revelation, or
more likely, but there's a revolution against a law that hurts home-grown industries and
employment.In the Senate, the medical
device tax lost in a rout, 70 to 29, big enough to withstand a Presidential
veto. Democratic Senators from traditionally liberal states –Massachusetts,
Minnesota. Washington State, Illinois, Maryland, and Connecticut – came out of
the woodwork to vote down the medical device excise tax.As the Wall
Street Journal editorial puts it, “All of this isn’t so much a change of
heart, but a full cardiac transplant.” To put it another way, negative
influences on your constituents may cause discontinuance of your previous point
of view.

Tweet:Innovation
is in– in labs where human organs growand in U.S. Senate, causing it to reject an innovation-stifling medical device tax.

The Health Reform Maze

Buy the Book

Book Description: In this first book in a series of four, Richard L. Reece, MD. provides a unique view of the roll out, and run up, of the Affordable Care Act. Reece shows in this book the progress and facets of ObamaCare's marketers and messengers, as the day approached for the launch of health insurance exchanges - the single most public and problematic portion of the new law. This is a must read for anyone who wants to chronicle this attempt to organize more than one-sixth of the U.S. economy by adding layers of federal government control and regulations.

Reece has been writing about U.S. health care for more than 45 years. His knowledge and experience, added to his keen intellect and gift of subtle humor, make this book a valuable part of anyone's collection.